In 2007, supported by an extraordinary team of family, friends, and medical staff, I stomped the snot out of a nasty cancer that was on its way to killing me. I've since learned that the way I did it has a lot in common with the advice of the "e-patients" movement, so I've changed my blogger name from Patient Dave to e-Patient Dave.

Friday, October 24, 2008

Before you jump to conclusions, see what this is about. This is "placebo" (Latin for "I believe") in its strict sense. From the NY Times:

Half of all American doctors responding to a nationwide survey say they regularly prescribe placebos to patients. The results trouble medical ethicists, who say more research is needed to determine whether doctors must deceive patients in order for placebos to work.

The study involved 679 internists and rheumatologists chosen randomly from a national list of such doctors. In response to three questions included as part of the larger survey, about half reported recommending placebos regularly. Surveys in Denmark, Israel, Britain, Sweden and New Zealand have found similar results.

The most common placebos the American doctors reported using were headache pills and vitamins, but a significant number also reported prescribing antibiotics and sedatives. Although these drugs, contrary to the usual definition of placebos, are not inert, doctors reported using them for their effect on patients’ psyches, not their bodies.

In most cases, doctors who recommended placebos described them to patients as “a medicine not typically used for your condition but might benefit you,” the survey found. Only 5 percent described the treatment to patients as “a placebo.”

Some people might react with alarm or outrage. (I imagine this might end up on the Most Emailed list.) The headline's misleading, actually, because for me anyway, it creates (at least for a moment) a sense that half of all doctors don't actually do anything meaningful, or trick us, or prescribing useless sugar pills (the common definition of placebo). A better headline might have been "Placebos widely used around the world."

More, though, I'm reminded of the medical value of one's attitude and beliefs. Placebos do produce some benefit, very often; that's why when any medication is tested, it must be compared against a placebo, to try to distinguish between "any unknown pill" and that specific medicine.

There's also the "white coat" effect, in which patients feel better when they've been through what feels like "getting help."

US healthcare reformers often talk about differences between the US system and other nations. What I hear in this store is that there's a global recognition among doctors (even if it's unspoken) that a patient's psyche can be a potent force in their well-being.